6.28 p.m.

Baroness Masham of Ilton: My Lords, I should like to thank the noble Lord, Lord Campbell of Croy, for giving your Lordships the opportunity of discussing this subject, which involves so many families throughout the UK as well as individuals with disabilities.

A short time ago I attended a lecture at the hospital for neurological conditions in Queen Square here in London. The consultant who spoke had an enormous list of different and varied conditions which came under the umbrella of neurology. Some of these are obvious; some are not. If the conditions are not treated by the experts, who above all are interested in the problems, the complications are manifold.

Beyond the field of neurology many other conditions result in disability. I know from first-hand experience that had I not been treated in a specialist spinal unit by experts, I should not be here in this House today. If I had to set one priority for the way in which the community in the United Kingdom can contribute to the alleviation of the many different kinds of disablement which occur from genetic problems, illness and accidents, it would be to have expert medical personnel who understand the various problems. If the conditions

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are not treated correctly, complications will arise. Treatment, research and rehabilitation all go hand in hand: treatment for the condition; research to find ways of stopping a condition happening or alleviating it, or to find ways of mending or regenerating nerves such as those in the spinal cord, which is so complex that nobody as yet knows how to do that; and rehabilitation to make the individual as independent as he possibly can be for as long as possible. Ongoing check-ups are also necessary so that the person can keep as well as possible in the community.

Of the many changes that have taken place in the National Health Servicesome of them necessary but some damaging the most worrying is that a number of the excellent specialising hospitals feel vulnerable even though they are recognised throughout the world. This is very serious for patients, who feel that their lifeline might be cut, and it is damaging for hospital staff, who want to get on and find ways of curing or alleviating complex conditions. If staff morale is bad, patients are affected.

Yesterday I attended the parliamentary carol service. I sat next to a charming man who was using a wheelchair. He had multiple sclerosis. How important it is to give such people hope that research is continuing. With the funding of extra-contractual referrals, problems are arising. Health authorities are saying that they will not pay for patients to go to specialised units if it is for research. But without research how can we hope for any progress in these devastating and complex conditions?

I am at the moment dealing with the case of a person who suffers from the results of organophosphorus poisoning from sheep dip. The health authority does not want to pay on the grounds that it is a matter of research and may not be of benefit to the person. At the moment there does not seem to be a cure. But, with interest, and with clever doctors doing tests and observing the symptoms, advances in treatment may be made. At least there will be hope that something is being done. That case is still unresolved. The health authority is looking at it, but relationships with the family and the general practitioner involved have almost broken down.

Another case was brought to my attention on Sunday night. In that case, relations with the GP had broken down and those involved were in the process of changing their GP. This was a case of ME, where the wife had had to give up her job as a result of exhaustion. If there is not to be a deluge of people leaving their GPs because of the Patient's Charter, should there not be more training of GPs in the many and varied conditions that result in different forms of disability? When relationships break down, stress increases and stress is not productive for anyone.

There is a new Bill before Parliament which provides for the merging of the health authorities and the FHSAs. That will cause a great deal of extra work, as mergers always do. I am concerned about the pressure on patients, whose needs should come first, because it is natural that staff will be looking to their jobs as a priority.

As I said, disability is very varied and complex. A new set of rules for people with intermittent disability will come into force in April. Such disabilities can be

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made worse by things that the patient does: by the exertion of walking or carrying out a task. I should like to ask the Minister: when people with those kinds of conditions come for assessment, how will the adjudicating medical officer take account of people's various levels of disability without medical evidence such as records and the advice of GPs and specialists? Will there not be many cases going to appeal? Will the new system not be more bureaucratic and cumbersome in the long run? Lots of appeals and tribunals will add stress for the disabled person. That is why I feel that there should be encouragement to general practitioners to take an interest in and understand disability. So often they just want to pass the problem on to the social services as a social issue. Given the pressure on health funding and the even greater pressure on social services, people with disabilities may well fall between the two and become very much at risk, with the danger of pressure sores, which cost the country millions of pounds, and a lack of help from social services with activities such as having a bath, which has now been cut to only one in every two weeks.

Yesterday, some noble Lords heard from the Association of County Councils that some social services were working on crisis programmes only. The tragic situation is that only severely disabled people are getting help. So many just need a little help to keep them going in the community. They are not getting that help. If the Government do not listen to the very many pleas for help, these problems will not be alleviated, they will be exacerbated.

Disabled people need adequate housing. If they use a wheelchair or have difficulty in walking, they need housing without steps, and suitable bathrooms and kitchens. The disabled population now includes those people with AIDS. There is an urgent need for flats with warden help. I hope that housing associations will extend their help here. They also need help with transport, as has been mentioned. Such help is vital, but it is not very often forthcoming in many rural areas. Such schemes as Dial-a-Ride and Taxicard are of great help. There are so many vital needs crying out for help.

As North East president of the Kidney Association, I was very concerned to read the following in the press on Monday:

"NHS units unable to cope with the rise in kidney patients".

Wherever I look I see the needs of many people with disabilities. I wish that the lottery money was going towards meeting some of those needs. However, we welcome the money that may come for disability and the arts. At least there could be tax relief, so that people who do pay taxes can offset against tax some of the extra costs that are due to their disability.

I look forward to the Minister's reply. I look forward also to the Bill on anti-discrimination legislation, because people up and down the country who have disabilities need it in this pressurised society.

6.40 p.m.

Lord Selsdon: My Lords, I feel that the scale of the problem which confronts usmy noble friend Lord Campbell of Croy, in his inimitable way has raised the

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matter again and drawn attention to one of the greatest issues that face our societyis perhaps matched by the scale of the opportunity. In preparing for this debate and lacking experience in this field other than as the member of a family which has many problems of a similar sort with disabilities across the board, I wondered whether we were back in the Dark Ages.

I walked through the Royal Gallery and looked at the two great pictures of war there. I recalled that if you were an able bodied seaman and had a splinter in your leg as a result of a cannon, you would lose that leg within a few days; or if you fought in the field of war on land, similar things would happen. I recalled as a small boy talking to my grandfather, of whom I was very proud because he had won the Sword of Honour at the Britannia Naval College. I wondered what he had done in the Great War, thinking that he must have risen to great rank. He had been invalided out at an early age because of Malta Dog. Wishing to join up, but having failed because he was disabled, he became a stretcher bearer at the front. Over Christmas he used to tell us stories of how he, as a stretcher bearer, would bring in someone with a wound and a surgeon would take off the limb there and then. He would be given that limb to dispose of and would wrap it in newspaper and bury it in a field, only to see it blown up or dug up by dogs a few days later. The horror at the scale of itdeath came not from being killed immediately but from disabilitymade me wonder, if I were faced with the choice of being severely disabled or dying, which one I should prefer.

Things have moved on since those days. There have been technological developments based upon research over time. There has been the development of antibiotics, obviously, and in the early days the development of artificial limbs to replace the pegleg stump. More recently there has been better use of technology and new materials.

Much has been done in this field but to me it is sad to find that we, the British, brilliant though we may be in the invention of new machinery and new technology, fail to obtain the research resources to develop and apply that technology. To illustrate that point, let me choose but one area: the orthopaedic area. Noble Lords will know that these days some of the most successful and common operations are the replacement of partsnothing more than the maintenance and repair that every car is expected to receive from time to time when components wear out. As we get older, our minds perhaps begin to outlive the capacities of our bodies. Our bodies may be in need of repair due to bone degeneration or as a result of accident brought about by a lack of stability. Such repairs are an area in which the British were pre-eminent. I refer to hip replacements, knee replacements, elbow and shoulder replacementseverything. It is of course based upon engineering.

At the end of the First World War there were many disabled who needed new limbs. Since then, there has been a need for replacements, for equipment and units, that often came from defence technology. Noble Lords will know that the retractable undercarriage ultimately led to the splendid, collapsible baby chair and often to the success of British designed cars in grand prix motor

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racing. But hip replacement is an area which has interested me. I am trying to help one of the organisations which raise money for those operationsthe Wishbone Appeal and the British Orthopaedic Association.

In the early 1960s there were two menMr. McKee and Mr. Charnleyboth of whom developed in parallel the first hip units. The joints were hinged and did not work very well. But to some extent they began to get rid of the disability which affects so many people: abject pain. Over time, perhaps over 10 years, that technology was developed by the London Splint Company and by Thackeray, two British companies which, sad to say, fell into American ownership. New developments arose. At present some 50,000 people in this country have hip replacements every year and with them goes the removal of pain. In the United States the replacement of knees has overtaken the replacement of hips, one of the most common operations of all time and almost guaranteed success.

But in this field, if there are no researchers, as the noble Baroness, Lady Masham, said, we fall behind. How far behind are we? I am told that, because of the technology available, we are desperately short of orthopaedic surgeons and that we have fewer doctors per 100,000 of the population than any European country other than Turkeyand there is a question of whether or not Turkey is in Europe.

These areas of development require money but they also require commitment. They require a mood. Your Lordships will be aware when a particular topic has, from time to time, captured a nation's imagination and the money, sponsorship and thought start to come forward. In the engineering divisions of our universities, there are ample numbers of people capable of pursuing and developing research alongside the Government, the orthopaedic organisations and others. One may be surprised to find that the grants that are made to universities by private individuals, often in their wills, are for the development of medical research in many fields.

It is a difficult and sad area. But I have had great pleasure when, from time to time, I have been involved in activities with the disabled. Yesterday we had our annual tea party for what are called "the children of courage". It was held after a very moving service in Westminster Abbey. Children who have committed acts of bravery are honoured and always half of them are those who have suffered from some major disability as a result of disease or an accident but they have come through smiling and shining. Yesterday, one small boy, who had lost one of his legs because of meningitis, announced with pride, as he showed his award to us all, that he was now hoping to be captain of the school football team, because of the technology that had come with the movements in engineering.

I do not know who in this country is responsible for the development of research in these fields. It is interesting that often the very people who have benefited as a result of technological development are those best able to promote and encourage the raising of more funds. Should your Lordships feel like attending, on 4th

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June next year we are having another of those "hippy walks"perhaps I might invite the right reverend Prelate the Bishop of Worcesterwhere disabled people who have had hip replacements walk a mile along the Thames, having a great day out. They are not raising money for charity but for research. Raising funds for research should not necessarily be charitable. There are many people who, if they knew that their personal effort of sponsorship was going into that field to alleviate suffering and help other sufferers, would put a lot more into it.

We have a long way to go. The Dark Ages are long past. We have the technological ability to develop equipment and services which can turn able bodied people who have become disabled into able bodied people again. It is only a matter of technology and commitment.